UBC Theses and Dissertations
Reasonable or unreasonable? : a patient-centred perspective of access to cannabis for medical purposes under different regulatory frameworks in Canada Capler, N. Rielle
Background: Since 2001, a medical cannabis program has existed in Canada with the goal of providing reasonable access to cannabis for medical purposes. However, reasonable access has not been defined, and few studies have investigated if reasonable access has been achieved and for whom since the implantation of the Marijuana for Medical Purposes Access Regulations (MMPR) in 2013. This dissertation sought to understand reasonable access to medical cannabis from a patient-centred perspective, including access to authorization and to sources of cannabis, during a transitionary period between regulatory frameworks. Methods: In 2014, a national sample of medical cannabis users participated in a cross-sectional, mixed methods study. A total of 369 individuals completed an online survey and 33 participated in semi-structured interviews. Bivariate and multivariate analyses were used to establish associations between patient- and system-related factors and access to authorization and sources of cannabis, and to compare satisfaction ratings between legal and illegal sources. An interpretive descriptive analysis was conducted to explore consequences of access. The Levesque patient-centred healthcare access model informed all phases of the study. Results: Few significant sociodemographic factors and medical conditions were associated with authorization status; however, associations were found regarding patterns of cannabis use. Authorized participants also experienced more problems accessing cannabis than unauthorized participants. Of legally authorized participants, half accessed illegal sources; those using only legal sources compared to those using illegal sources differed regarding the characteristics of products and services they considered important. Highest satisfaction levels were reported for sources closest to production and those providing in-person service. Participants experienced considerable health, legal, financial and social consequences from their access experiences. Conclusions: Reasonable access to medical cannabis was not achieved for many participants in this study. Patterns of use and perceived quality of products and services may have influenced both access to the program and to sources at different stages of access, resulting for some in the use of medical cannabis outside the legal framework. Patient-centred research on access to medical cannabis is necessary to establish whether reasonable access has been achieved, and future research must assess the impact of legalized recreational cannabis on access.
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